Page 23 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter I. Introduction

These recommendations were based on limited, although consistent, literature. The use

of HPV testing, cervicography, and colposcopy lacked evidence in the literature to support

routine use. Recommendations against use were based on other grounds, including poor

specificity and costs.

Recommendations of Other Groups

Table 2 summarizes the recommendations of 9 selected US organizations and other

international groups and health systems with guidelines based on evidence review. We note

information on starting age, interval, adaptation of interval for high-risk women, upper age limit

for screening, and discontinuation after hysterectomy.

Intervals range from 2 to 5 years, in some cases with modification for individual risk and

in some cases irrespective of risk. The most commonly advised screening interval is 3 years

after a specified number of qualifying prior normal smears.

Six of the 9 groups suggest discontinuation among older women with prior normal

screening history: The UK National Health Service Cancer Screening Programmes at 64; the

American College of Preventive Medicine and the Institute for Clinical Systems Improvement at

65; the Canadian Task Force on Preventive Health Care at 69; and the National Cervical Cancer

Screening Programs of Australia and New Zealand at age 70. Three specifically mention

discontinuing testing after hysterectomy for benign disease.

No guidelines specifically address the utility or advisability of using new cytology

technologies or HPV testing for screening or triage, within a screening system, except in noting

that HPV infection is a high-risk factor that may guide choice of interval.

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